The influence of social factors on gender health

Male births exceed female births by 5-6% (for a sex ratio at birth of 1.05-1.06) while a women's life expectancy, on a global scale, is about 6 years longer. Thus within various age groups the male:female ratio changes over time. Until age 50 years men outnumber women; thereafter their numbers show a sharp decline. Consequently at age 80 years, there are many more women than men. An estimated 25% of this male excess mortality is due to biological causes, the rest being explained by behavioural, cultural and environmental factors. For both women and men, the main health risks related to lifestyle are smoking, alcohol, unhealthy diet and physical inactivity. In the year 2010, overweight (BMI: 25-29 kg/m2) and obesity (BMI: >30 kg/m2) were responsible for over 3 million deaths, with similar relative risks in men and women for overweight and obesity. Smoking and alcohol are the major causes of the global gender gap in mortality. For women in some parts of the world however pregnancy is also hazardous. On a global scale, in 2013 about 300 000 deaths were related to pregnancy, with sub-Saharan Africa registering the highest maternal mortality: over 500 maternal deaths per 100 000 births. Additional woman's health risks arise from gender discrimination, including sex-selective abortion, violence against women and early child marriage. Providers should be aware of the effect that these risks can have on both reproductive and general health. © 2016 The Author

The effect of intramural fibroids on the outcome of IVF

Objective: To evaluate the effect of fibroids on outcome of IVF and study value of myomectomy prior to IVF. Design: Prospective controlled study. Setting: Private IVF center, The Egyptian IVF ET Center, Maadi, Cairo. Materials and methods: One hundred and eighty four patients were included. Sixty three patients with intramural fibroids were counseled for either myomectomy or no treatment prior to IVF and decision left to the patient. Group A, N=19 were treated by myomectomy, Group B, N=44 had no myomectomy. Group B were subdivided into B1, N=11 with fibroid at a distance < 5 mm from the endometrial lining and B2, N=33 at a distance of > 5 mm. Group C, N= 100 were an age-matched group of infertility patients. Group D included 11 submucous fibroids and 10 fibroid polyps that were all treated by hysteroscopic resection. Main outcome Measures: Size and distance of intramural fibroid to endometrial lining were recorded. Outcome of IVF was compared between fibroids at a distance > 5 mm and < 5 mm from endometrial lining. As well as outcome between group that performed myomectomy and that which did not undergo myomectomy. Results: Pregnancy rates achieved in the three groups A, B and C were; 50%, 27.5% and 36% respectively. This was found to be non significant. In subgroup B1 there was one pregnancy (9%) as compared to 10 pregnancies in subgroup B2 (30%). The difference was non significant. Following hysteroscopic resection 2 out of 6 patients with submucous fibroids and 6 out of 10 patients with fibroid polyps became pregnant after IVF. Conclusions: The distance between the intramural myomas and the endometrial lining did not affect the IVF outcome. An insignificant tendency towards improvement of IVF outcome was found in myomas at more than 5 mm from endometrial lining

Three dimensional endometrial volume versus endometrial thickness measurement in prediction of IVF/ICSI outcome

Objective: To investigate the role of estimating endometrial volume and it's correlation with endometrial thickness, on the day of hCG, in prediction of IVF outcome. Design: A prospective clinical study. Materials and methods: Endometrial volume and endometrial thickness were measured in women undergoing an IVF/ICSI cycle, on the day of HCG, using the 3 D transvaginal ultrasound probe (Sonoace 9900 Medison -Kretz , korea). Patients were divided according to endometrial volume calculated into 3 subgroups; 4 ml, as well as according to endometrial thickness into 3 groups; <8mm, 8-12mm and >12mm. Pregnancy rates were compared between all groups. Results: The study included 103 women with no significant difference in background characteristics between all subgroups. The pregnancy rates between the three groups of endometrial volume; <2ml, 2-4ml, and >4 ml was; 42%, 36% and 48% respectively. Pregnancy rates between the three groups of endometrial thickness was 25%, 40% and 50 % for 12mm respectively. There was no significant difference in pregnancy rates between all groups in relation to both endometrial volume and endometrial thickness. Conclusion: Endometrial volume on day of hCG is not a better predictor than endometrial thickness for determining outcome of IVF/ICSI cycles

Difficult embryo transfer: the impact of propofol anesthesia

Background: Difficult embryo transfers (ET) requiring general anesthesia are occasionally encountered in clinical practice. Little evidence is present in the literature as to the success rates when compared with difficult transfers not requiring anesthesia. Objective: To evaluate the impact of using Propofol anesthesia during difficult embryo transfers on the implantation and clinical pregnancy rates. Design: Retrospective patient chart review. Materials and methods: Women undergoing ICSI cycles in the Egyptian IVF-ET center, from January 2000 December 2002, and having difficult ET requiring general anesthesia (Group I = 99 women) were included. A matching group of women with difficult ET, without anesthesia (Group II = 99 women) were used as a control. Results: There were no significant differences in the patient demographics (e.g. age, period of infertility, number of oocytes retrieved, fertilization rate, embryo quality, number of embryos transferred. Moreover, there was no significant differences in implantation (Group I = 19.15%, Group II = 20.86%) or clinical pregnancy rates (Group I = 36.36%, Group II = 33.33%). Conclusion: The use of propofol general anesthesia during difficult embryo transfer does not seem to improve the implantation and pregnancy rates. Even though, prospective randomized trials are needed to confirm these findings

Karyotyping and neurodevelopmental follow-up of intracytoplasmic sperm injection children up to 4years of age

Objectives: The aim of this work is to study ICSI babies, singleton and twins and compare them with singleton naturally conceived children from the genetic and neurodevelopmental point of view. Materials and methods: This is a prospective study performed on 120 children born to 100 mothers after the successful treatment of male infertility by intracytoplasmic sperm injection (ICSI). Obstetric history and Neonatal examinations were done. Developmental assessment using Denver Developmental Screening Test was done at 1, 2, 3, and 4years of age. Karyotype was done to all babies. The babies were divided into three study groups; group 1 single ICSI, group 2 twin ICSI, and group 3 normally conceived control group. Results: We found no statistically significant difference when we correlated outcome of DDST to gender, mode of delivery, smoking habits of mother, maternal illnesses, paternal smoking, Apgar score, congenital anomalies or type of feeding. There was significant statistical difference between the results of DDST follow-up and gestational age, birth weight and NICU admission. Our developmental assessment using DDST reported that ICSI children in both groups do not display any significant developmental delay when compared with naturally conceived children. Conclusion: Developmental assessment performed in this study revealed reassuring findings, no important differences between ICSI and NC children were noticed indicating that infertility treatment by ICSI technique does not appear to affect the development of child. It also highlights the need for continuous follow-up to evaluate whether ICSI children continue to show satisfactory development later in life